Summaries for Patients|1 January 2002

Prednisone for Rheumatoid Arthritis

The summary below is from the full report titled “Low-Dose Prednisone Therapy for Patients with Early Active Rheumatoid Arthritis: Clinical Efficacy, Disease-Modifying Properties, and Side Effects. A Randomized, Double-Blind, Placebo-Controlled Clinical Trial.” It is in the 1 January 2002 issue of Annals of Internal Medicine (volume 136, pages 1-12). The authors are AA van Everdingen, JWG Jacobs, DR Siewertsz van Reesema, and JWJ Bijlsma.

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What is the problem and what is known about it so far?

Rheumatoid arthritis (RA) is a chronic disease that causes painful, swollen, and deformed joints. It is caused by inflammation of the tissue linings (membranes) of joints and most often affects many small joints of the hands and feet, but may develop in any joint. People with RA usually have chronic joint pain and stiffness. There is no cure for RA, but signs and symptoms can be treated. Persistent arthritis is painful and destroys joints, and about 1 in 10 persons with RA may eventually become severely disabled from joint destruction. Several powerful drugs, named disease-modifying antirheumatic drugs (DMARDs), reduce both symptoms and the risk for permanent joint damage. Other drugs, known as glucocorticoids (prednisone), reduce inflammation and improve symptoms. Recent studies suggest that prednisone also can help prevent joint damage in patients who are taking DMARDs. Whether prednisone prevents joint damage in patients who do not use DMARDs is unclear.

Why did the researchers do this particular study?

To see whether low doses of prednisone prevent joint damage in adults who have early active RA but have little joint damage and use no DMARDs.

Who was studied?

81 adults who had had RA for less than 1 year. None had been treated with DMARDs. Most (64%) were women, and the average age was about 60 years.

How was the study done?

Patients were randomly assigned to receive prednisone (10 mg daily) or placebo (dummy pill) for 2 years. Neither the patients nor their physicians were told who got prednisone or dummy pills. To measure the effect of treatment, the authors assessed joint symptoms and x-rayed the joints every 6 months.

What did the researchers find?

At 6 months, patients who took prednisone had fewer symptoms (joint stiffness, swelling, and tenderness) and better grip strength. During the study, they also used fewer additional therapies (for example, nonsteroidal anti-inflammatory drugs) than patients given dummy pills. One and 2 years after starting treatment, x-rays showed less joint damage with prednisone than with dummy pills. Five patients given prednisone and 2 patients given placebo developed fractures in the small bones of their backs.

What were the limitations of the study?

This study was started almost 10 years ago, before doctors routinely used DMARDs for all patients with RA. Also, patients in this study received only calcium to prevent thinning of their bones and fractures. Using newer therapies in addition to calcium might prevent fractures related to prednisone. Finally, the authors did not test the effect of even lower doses of prednisone, such as 2.5 or 5 mg daily.

What are the implications of the study?

Prednisone in dosages of 10 mg daily improves symptoms in patients with early active RA and prevents progression of joint damage, but it also increases risk for bone fractures.

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